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Cardiology > Stable Angina > Flashcards

Stable Angina Flashcards

1
Q

What is Angina due to?

A

Narrowing of the coronary arteries due to atherosclerosis causes reduced blood flow to the myocardium

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2
Q

How many classes of angina are there?

A

Four

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3
Q

What is class 1 of Angina?

A

Only on strenuous or prolonged physical activity

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4
Q

What is class 2 of Angina?

A

slight limitation, with angina only during vigorous physical activity

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5
Q

What is class 3 of Angina?

A

Symptoms with everyday living activities

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6
Q

What is class 4 of Angina?

A

Inability to perform any activity without angina or angina at rest i.e. unstable angina

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7
Q

What is the Gold standard for the diagnosis of Angina?

A

CT Coronary Angiography

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8
Q

What is a CT Coronary Angiography?

A

Injecting contrast and taking CT images timed with the heart beat, highlighting any narrowing.

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9
Q

What other investigations should you carry out for Angina?

A

ECG
Echocardiogram
Exercise stress tests with a ECG

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10
Q

What are the 3 aims of treatment?

A

Immediate symptomatic relief
Long term symptomatic relief
Secondary prevention of cardiovascular disease

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11
Q

What is administered for immediate symptomatic relief?

A

GTN spray

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12
Q

What does GTN spray cause?

A

Vasodilation

Helps relieves the symptoms.

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13
Q

How should GTN spray be administered?

A

Take GTN, then repeat after 5 minutes.

If there is still pain 5 minutes after the repeat dose – call an ambulance.

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14
Q

What is given for long term symptomatic relief?

A

Beta-blockers

Calcium channel blockers (CCB’s)

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15
Q

What is given for secondary prevention of cardiovascular disease?

A

Beta-blockers

Calcium channel blockers (CCB’s)

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16
Q

Which and what does of Beta blocker is given?

A

Bisoprolol

5mg daily

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17
Q

Which and what dose of calcium channel blocker is given?

A

Amlodipine
5mg daily

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18
Q

What is the possible surgical management of Angina?

A

PCI

CABG

19
Q

Which drugs are commonly given for secondary prevention?

A

Aspirin (i.e. 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor

20
Q

What are other possible drugs for angina that are not first line?

A

Long acting nitrates (e.g. isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine

21
Q

If angina is stable, what is it always relieved by?

A

Rest or GTN

22
Q

When would angina be considered as unstable?

A

If the symptoms were occurring at rest

23
Q

Where is the site of anginal pain?

A

Retrosternal

24
Q

What is the character of anginal pain?

A

Tight band
Pressure
Heaviness

25
Q

Where does anginal pain radiate to?

A

Jaw
Neck
Arms

26
Q

What aggravates anginal pain?

A

Exertion
Emotional distress
Cold weather
Heavy meals

27
Q

What are relieving factors of angina?

A

Rest
GTN

28
Q

How is angina graded?

A

CCS (canadian cardiovascular scale)

29
Q

What happens to the heart muscle as a result of angina?

A

Ischaemia occurs when myocardial oxygen demand is greater than supply
Atherosclerotic plaques narrow the lumen of the coronary arteries

30
Q

What is stable angina?

A

When symptoms of angina are always relieved by rest and GTN spray

31
Q

What is unstable angina?

A

When symptoms come on randomly whilst at rest

32
Q

What is the most common cause of angina?

A

Atheroma

33
Q

What are non-modifiable RF for angina?

A
  • age
  • male gender
  • family history of ischaemic heart disease
34
Q

What is the first line long term treatment for stable angina?

A

Monotherapy of CCB or BB

35
Q

What are the 2 main side effects of GTN?

A

Headaches
Dizziness

36
Q

If a CCB is being used as montherapy, which drugs should be used?

A

Verapamil or diltiazem

37
Q

What is the problem with verapamil and diltiazem?

A

Avoided in heart failure with reduced ejection fraction

38
Q

If using a CCB in combination with a BB, which CCB should be used?

A

Amlodipine

39
Q

if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker, which medications can be offered?

A

Long-acting nitrates (e.g., isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine

40
Q

If a patient is taking both a CCB and a BB and still having symptoms, what can be added?

A

Long-acting nitrates (e.g., isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine

41
Q

How long should patients be taking 3 drugs for angina?

A

Whilst a patient is awaiting assessment for PCI or CABG

42
Q

What interventions can be offered for angina?

A

PCI
CABG

43
Q

What is the problem of prescribing verapamil and a beta blocker together?

A

Complete heart block

Cardiology (66 decks)

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